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Texas rates for HCPCS 50694

Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy), and all associated radiological supervision and interpretation; new access, without separate nephrostomy catheter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.00 / $3,000.00 / $10,546.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,642.82 / $4,769.29 / $9,689.51
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.45 / $2,638.80 / $2,638.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,376.10 / $2,376.10 / $2,376.10
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $2,081.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.38 / $841.30 / $1,881.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.38 / $941.77 / $2,417.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00